Influence of low FODMAP and gluten-free diets on disease activity and intestinal microbiota in patients with non-celiac gluten sensitivity. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Dieterich, Walburga; Schuppan, Detlef; Schink, Monic; Schwappacher, Raphaela; Wirtz, Stefan; Agaimy, Abbas; Neurath, Markus F.; Zopf, Yurdagül
• Is Part Of: Clinical nutrition. Volume 38:Issue 2(2019)
• Page Start: 697
• Page End: 707
• Publication Date: 2019-04
• Subjects: Non-celiac gluten sensitivity -- Microbiota -- Gluten-free diet -- Low FODMAP diet; ANOVA analysis of variance -- ATI amylase-trypsin-inhibitor -- BMI body mass index -- FODMAP fermentable oligo-, di- and monosaccharides and polyols -- IBS irritable bowel syndrome -- IEL intraepithelial lymphocyte -- MWU Mann-Whitney-U test -- NCGS non-celiac gluten sensitivity -- PAS periodic acid-Schiff's reagent -- PGWB psychological general well-being index -- GSRS gastrointestinal symptom rating scale -- RAST radioallergosorbent test; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.03.017
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Non-celiac gluten sensitivity (NCGS) is characterized by intestinal and extra-intestinal symptoms triggered by ingestion of gluten. However, non-gluten triggers have recently been implicated, and a FODMAP (fermentable oligo-, di-, monosaccharides and polyols)-reduced diet can partially improve symptoms in NCGS. Our aim was to analyze the effect of a low FODMAP versus a gluten-free diet (GFD) on clinical symptoms, psychological well-being, intestinal inflammation and integrity, and stool microbiota. Methods: Nineteen patients with NCGS and ten healthy controls consumed a gluten-containing standard diet before starting a two-week low FODMAP diet; after a five day transition period, participants ingested a GFD for another two weeks. The primary outcome measure was the improvement of clinical symptoms in NCGS patients under the different diets. Secondary outcomes were the determination of dietary effects on intestinal inflammation, psychological well-being, and differences in stool microbiota between NCGS patients and controls. Results: The low FODMAP diet and especially the GFD led to a significant improvement of clinical and psychological symptoms in NCGS. A clear reduction in duodenal intraepithelial lymphocytes and mucin-producing Goblet cells was found after the GFD in these patients. Significant microbial differences between NCGS patients and controls were noticed in stool samples at every time point. Both diets caused microbial shifts in all participants, with a greater variability on genus level and metabolisms groups in NCGS patients. Conclusions: Our findings suggest a multifactorial etiology of NCGS, due to a functional effect caused by FODMAPs, combined with a mild gluten-triggered immune reaction, and a microbiota dysbalance. ClinicalTrial.gov ID: :NCT03268720 .